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Thursday, April 4, 2013

The high cost of covering adults with preexisting conditions before 2014 could signal greater costs for all individuals within the broader health insurance market, a health economist warned lawmakers.

The Pre-Existing Condition Insurance Plan (PCIP), which the Affordable Care Act (ACA) created as a way to provide health coverage to those with preexisting medical conditions before other aspects of the law take effect in 2014, does nothing to reduce the costs of care for those patients, Thomas Miller, JD, resident fellow at the conservative American Enterprise Institute here, said at a congressional hearing Wednesday.

Despite garnering only 110,000 enrollees -- far less than the 375,000 expected -- the PCIP program has run out of the $5 billion Congress gave it.

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The concern is that those with preexisting conditions could spell more trouble for the broader population if more healthy young people -- those still paying premiums but not using as many services -- don't sign up for health coverage when open enrollment starts later this fall. Health insurance companies would need those premiums to help offset the most expensive individuals it would have to cover.

No Democrat and only two Republicans attended the hearing while Congress was out of session and most lawmakers were back in their home districts.

However, the committee's top Democrat, Rep. Henry Waxman (Calif.), issued a statement supporting the ACA while adding the law's reforms starting next year will better solve the problems PCIP tried to address.

"The program was always designed to be a temporary solution to help some of the sickest Americans who had been locked out of the insurance market to get coverage," Waxman said. "It was also set up to be more accessible than the many state high-risk pools that have high premiums, long waiting lists, or are closed to new enrollees, as Florida's has been for more than 20 years."

To read the full article, please click here for access to Medpage Today.